I help you to realize that you have the abilities, wisdom and courage to give birth. Birth is something that you know on a basic level. I just help you to access that knowledge. - Jacquie Munro

Thursday, October 02, 2008

Ticking the "Home" box

A former client recently emailed me, asking me to write a post about home birth. Was she searching for information for the ongoing debate with her husband? Even though it is the woman who must ultimately make the decision about her birth setting, it is imperative that her partner is included in the process of informed choice, and comes to understand and support her decision, without fear.

Since I'm known as the research-oriented and pragmatic doula, I'd better throw in some evidence. So, here are a few things I want you to consider:

1. When you are presented with two equally effective treatments, then "best practice" requires that you take into account the patients' preferences (that means HER).

2. The Province of British Columbia Ministry of Health fully funds care by registered midwives, both at home or hospital.

3. A 1986 World Health Organisation report concluded that “home is the most appropriate birth setting for most childbearing women. Women (and their attendants) choosing this option must be provided with necessary diagnostic, consultative, emergency and other services as required, regardless of place of birth.” See College of Midwives of British Columbia.

4. In 2002, the "Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia" was published in the Canadian Medical Association Journal. The results showed that "women who gave birth at home attended by a midwife had fewer procedures during labour compared with women who gave birth in hospital attended by a physician.""Comparison of home births with hospital births attended by a midwife showed very similar and equally significant differences." The final interpretation of the study was that "there was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife."

5. In September 2007, the UK National Institute for Health and Clinical Excellence issued clinical guidelines (The NICE Intrapartum Care Guidelines) on intrapartum care of healthy women and their babies during childbirth. Under ‘‘key priorities’’ it stated: ‘‘Women should be offered the choice of planning birth at home.’’ Information suggests that for ‘‘women who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention’’.

After attending almost 800 births in my 21 years as a doula, I can now say that I'm most comfortable (and I feel most safe, actually) at a home birth, with a client who has come to this decision freely, who is autonomous, who is radiantly healthy, whose midwives (there are always two present) are trusted and respected by all of us, and who has a partner who fully supports her decision without fear. But that's me...now.

I can't squish a woman into that mold. I would never want or expect everyone to be "that woman". A woman must go on her own unique and challenging journey to trust birth that much. I trust each woman to make the decision regarding the best place FOR HER to give birth, and with whom to give birth. I support each woman without reservation, no matter what her choice. In order to give birth at home, a woman has to gradually grow into the person who can make that decision. I know I didn't reached the point where I would have chosen home birth until I was 31, after giving birth to two children, and after attending over 100 births (many at home). Until then, I simply didn't have enough information to make an informed choice about home birth myself, even though I HAD made the amazing, and life-changing, leap to midwifery care for my second birth!

So, to the couples who are spending evenings debating home birth (she wants it...he's not sure...grandma says "over my dead body"), please do your homework. The research is clear. The more difficult task is to deal with the images swirling in your heads - images born of myth, misinformation, and fear, fueled by society's expectations and the media's lopsided representation of birth. You need to talk to people (call me - my clients would love to share!) about their personal experiences of home birth, watch movies which include home births (like The Business of Being Born or Le Premier Cri), and understand that choosing home birth doesn't lock you into that option. It just means that you can now include another option in your choice of birth places - you can now tick the "home" box.

When asked where she was planning to have her baby, one family doctor with four children would always say, "Wherever it wants to come out!" (In the end, she had #1, #3 and #4 at home, and #2 at the hospital) Because...on the big day, if you've given the body and the baby both options (hospital AND home), their final choice is always loud and clear!

Now, if I could only let you into my head to see the images of the home births that I've attended...but that's for the next post...

Jacquie

Sarah with her boys

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About Us

I have been interested in birthing issues since I studied developmental psychology at UBC in the early 1980's, focusing on mother/child interaction and language development.

I put my studies to practical use during my two pregnancies, first with medical care (Sarah), then with midwifery care (Alex). After my inspirational experience with midwifery care, I worked to promote the registration of midwives in BC, and became involved in our local birthing community.

Over the next few years I became a Certified Childbirth Educator and, after teaching hundreds of couples, I tried out my own experiment, and attended the births of an entire prenatal class, just to see if it would make a difference - and it did! All those births were straight-forward and without complication. I was on to something! From then on, my focus began to shift toward providing support for couples throughout their pregnancy, birth, and postpartum period. A doula had been born (even though it was years before the term "doula" was coined).

I've been the Coordinator for Vancouver Childbirth, taught prenatal classes with Vancouver Childbirth and Kwantlen College, helped to develop the Douglas College Doula Course, was DONA-certified doula #16, the BC DONA representative, developed a holistic childbirth education series for The Midwifery Group, and developed a Slow and Simple parenting series with Pacific Midwifery.

I work closely with my daughter, Sarah (see more info below), and your "birthing team" (midwives, family doctors, lactation consultants, and complementary caregivers), to provide the best care for families during the childbearing year. I stay current by attending 4-5 births a month, attending workshops and conferences, networking, reading and researching "best evidence" during every spare moment, as well as listening to my most willing teachers - our clients and their babies.

Since 1987, I have provided doula care to over 1020 women and their families at home and in the hospital, and have taught thousands of expectant parents. I currently work solely as a doula in private practice. (Just to let you know, baby #3 is living in Colorado with her little son, baby #10 is a classical pianist, baby #15 is working on his Masters at SFU, and baby #1021 is feeding happily at home with her mum and dad.)

Outside my life as a doula, I love to hug my ever-expanding family (including twin grandsons!), ride my road and Mamachari bikes daily, am a literary junkie, and slow travel with my husband.

Email me or call me and let's have a chat!

- Jacquie

Sarah Munro

Sarah Munro (BA Hons, MA, PhD student) is a Vancouver-based doula, breastfeeding counselor, and mother of twins who has been providing perinatal support for birthing women since 2007. Working with birthing families bridges her passions for childbirth, breastfeeding, and research. In addition to providing doula support, Sarah is pursuing her PhD in Interdisciplinary Studies in health services and bioethics, specifically: "Birth after a previous caesarean section: Health communication strategies to enhance decision making". She is a Child and Family Research Institute Trainee and Western Regional Training Centre for Health Services Research Trainee. She is honoured to be providing doula back-up for Jacquie.

Please check out the "Vancouver Doula" section below for more information about the care we provide.

Photography

Blog Friends

Jacquie Munro, founder of the "Slow Birth" movement, is an experienced doula and childbirth educator and is well-known for her individualized, intuitive approach to supporting families in the childbearing year and beyond. Since 1987, she has provided support at over one thousand births, at home and in hospital, and taught thousands of expectant parents. At home, Jacquie lives only a bike ride away from four generations of her family. You can usually find her at the park or beach, playing beside her twin grandsons who call her "Deecy".